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Objective-In this systematic review we evaluated the effectiveness of emergency department (ED)-based management interventions for mental health presentations with an aim to provide recommendations for pediatric care.Methods-A search of electronic databases, references, key journals and conference proceedings was conducted and primary authors contacted. Experimental and observational studies that evaluated ED crisis care with pediatric and adult patients were included. Adult-based studies were evaluated for potential translation to pediatric investigation. Pharmacological-based studies were excluded. Inclusion screening, study selection, and methodological quality were assessed by two Conclusions-Pediatric studies have demonstrated that the use of specialized care models for mental health care can reduce hospitalization, return ED visits, and length of ED stay. Evaluation of these models using more rigorous study designs and the inclusion of patient-based outcomes will improve this evidence base. Adult-based studies provided recommendations for pediatric research including a focus on triage and restraint use.

We would like to point out a preliminary study which investigated the effects of cholesterol-reducing agents on the serotonin-related behaviour in vivo (Dursun, 1992). Rather high doses of cholesterol-lowering agents, gemfibrozil and cholestyramine, both significantly blocked the inhibitory action of a serotonin-lA receptor agonist ligand on the serotonin-2 receptor mediated-behavioural response (head-shakes), while gemfibrozil significantly potentiated this behavioural response and cholestyramine showed a trend towards potentiation of the same behaviourin rodents (signifi cantly low plasma cholesterol levels compared with control animals have been confirmed by biochemical studies after behavioural studies) (Dursun, 1992). These preliminary results show that cholesterol lowering agents can indeed alter both serotonin-2 receptor-mediated behaviour and a serotonin-1A/ serotonin-2 receptor interaction in vivo. Therefore, alterations of the functional state of the serotonin receptor subtypes and their interactions by the cholesterol-lowering agents may be implicated in understanding the involvement of serotonin in the relationship between low serum cholesterol and suicidal behaviour. However, further precliical and clinical research is needed to understand the mechanisms of this relationship.

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The case of a patient who developed a severe hypotensive reaction with a persistent hemianaesthesia following the addition of lithium carbonate to her treatment regimen is described. The patient had been receiving chlorpromazine therapy for the management of hypomania and the addition of lithium carbonate to the chlorpromazine produced a severe hypotensive episode which compromised her neurological functioning. Only three doses of lithium carbonate had actually been taken by the patient. This type of hypotensive response associated with the simultaneous use of chlorpromazine and lithium has not previously been noted in the literature.